Clinical Transplant Associate
Primary Location Los Angeles, California
Worker Location Remote
Job Number 1332852 Date posted 01/30/2025
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Description:
Supports the Transplant Coordinators case management efforts through clinical data collection, referral/authorization management, accessing appointments and consultations, facilitating the communication of medical information to the providers, managing data collection for administrative purposes, and coordinating travel arrangements and reimbursements for the members.
Job Summary:
Supports the Transplant Coordinators case management efforts through clinical data collection, referral/authorization management, accessing appointments and consultations, facilitating the communication of medical information to the providers, managing data collection for administrative purposes, and coordinating travel arrangements and reimbursements for the members.
Essential Responsibilities:
- Referral Management: Manages local regions referral review process for transplant authorizations; collects supporting documentation from available sources and presents case to reviewer per local region procedure. Anticipates leakage out of the Network and develops processes to find and correct it according to local region policy and procedure and NTN exemption process.
- Generates and ensures communication of authorizations to the referring provider, COE, member and claims unit. Collaborates with the Transplant Coordinator, and local region Utilization Management to ensure that the process fulfills all regulatory requirements. Collaborates with the claims department to ensure that claims are paid according to the appropriate contract and fee schedule.
- Educates local providers regarding the referral process for Transplant Services; develops and implements systems to ensure that 98% of referrals for Transplant Services occur within Centers of Excellence.
- Consistently supports compliance of responsibility (Kaiser Permanente code of conduct) by maintaining the privacy and confidentially of information, protecting the assets of the organization, acting with ethics and integrity, reporting non compliance, and adhering to applicable, federal, state, and local laws and regulations, accreditation, and licensure requirements (if applicable), and Kaiser Permanente policies and procedures. Performs all other duties as assigned.
- Clinical Information Management: Collects COE /Organ specific clinical information for the members with approved referrals for transplant; collaborate with the Transplant Coordinator to ensure that information is timely and complete.
- Collaborates with the Transplant Coordinator to ensure accurate and complete Hub Intake Form. Develops and implements systems for ensuring that clinical information from the COE or referring provider is received by the intended recipient in a timely and user friendly manner.
- Develops processes and implements monitors for local region in-patient census to identify case managed members that have been admitted to an in-patient facility. Collects clinical information for members approved for transplant; collaborates with transplant coordinator and physicians to ensure that information is timely and complete. Performs order entry functions as directed by transplant coordinators and clinicians.
- Collaborates with transplant coordinators to ensure that accurate information is forwarded to the COE and or retrieved from the COE. Triages requests for clinical information from COE on behalf of transplant coordinators and clinicians.
- Access to Clinical Services: Anticipates delay in processes and works to ensure members timely access to required consultations/diagnostic procedures requested by COE. Coordinates appointments for consultations/diagnostics with providers and members according to the medical indication.
- Reduces redundancy and outside costs by collaborating with the transplant coordinator to maximize repatriation of services whenever it is clinical appropriate and within the confines of the members contract with the Health Plan.
- Ensures that authorization for outside services are accurate and communicated to all effected parties. Ensures that appointments are consummated within the medically relevant timeframe and follow up expectations are clear.
- Travel Support: Receives Verification of Per Diem from Transplant Hub and ensures payment is made to member; collaborates with the Transplant Coordinator, if the member is not under Hub management, to determine if Per Diem payments are appropriate and ensure accurate payment.
- Collaborates with the Transplant Coordinator when the Hub does not manage member, to determine when out of area travel to the COE is medically necessary, and coordinates travel services in a cost-effective manner. Educates members about their local region benefits and travel support policies and procedures.
Basic Qualifications:
Experience
- Minimum three (3) years of experience in utilization management (required on original description).
Education
- Bachelors degree, OR four (4) years of experience in health care administration, or related field (i.e. Clincial Transplant Care etc.).
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Strong problem solving and organizational skills.
- Works well in multi-tasking team environment.
- Competent in computer skills.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Minimum one (1) year of experience in an ambulatory clinical setting preferred.
Primary Location: California,Los Angeles,4733 Sunset Annex
Scheduled Weekly Hours: 1
Shift: Day
Workdays: Mon, Tue, Wed, Thu
Working Hours Start: 08:00 AM
Working Hours End: 02:30 PM
Job Schedule: Call-in/On-Call
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: NUE-PO-01|NUE|Non Union Employee
Job Level: Entry Level
Department: Po/Ho Corp - National Transplant Services - 0308
Pay Range: $33.46 - $43.25 / hour
Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Remote: Work location is the remote workplace (from home) within KP authorized states.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
